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GENERAL SURGERY: Goals and Objectives
Residents
PGY-5
PGY-2/3
PGY-1
Objectives
The objective of the service is to educate the residents about the pathophysiology, diagnosis and treatment of the surgical patient. The resident is expected to have a clear working knowledge of the evaluation, pre-operative preparation, surgical treatment (including intra-operative decision making) and post operative care of patients presenting with surgical diseases including but not limited to the following general areas:
Gastrointestinal disorders
l Benign hepato -pancreato -biliary
l Pancreatitis
l Peptic ulcer
l Benign and malignant colorectal disease
l Anorectal disease
Surgical emergencies
l Appendicitis
l Diverticulitis
l Bowel obstruction
l Soft tissue infection
l GI bleeding
l Intestinal ischemia
l Esophageal perforation
Hernia
Morbid obesity
Nutrition
Surgical infection
Responsibilities
PGY-5
1. The PGY-5 is expected to run the clinical service; the chief will maintain 24 hour/day beeper availability; i.e., after hospital hours he/she will be available by beeper for service/administrative responsibilities, questions or patient care issues.
2. Care of surgical consults referred to the service. This is both in terms of initial evaluation (either the PGY-5 or the PGY-2/3) and subsequent planning of care.
3. The resident is responsible for team attendance to weekly Morbidity and Mortality, Grand Rounds, and all relevant scheduled conferences.
4. Operating room. The chief resident will operate with an attending on the general surgery service. The chief is responsible for assigning OR coverage every day of the week.
5. Education. The chief resident should achieve competence in evaluating the patient with cancer, formulating differential diagnoses and developing a diagnostic approach. The resident should be knowledgeable about the surgical management of the various aspects of general surgery. Emphasis will be weighted toward patients with GI, hernia, morbid obesity, and general surgical emergencies. The resident will be evaluated on their competence in the operating room in terms of operative preparedness, treatment plan, procedural skill and operative judgment is a primary goal.
6. The chief resident in charge of the General Surgical team will assist the chief resident on the Surgical Oncology service in the role as the University Hospital Administrative Chief.
PGY-2/3
1. The daily care of all inpatients admitted to the General Surgery service. The resident should know all information regarding clinical course, management and plan on each patient.
2. Care of surgical consults referred to the service. This is both in terms of initial evaluation (either the PGY-5 or the PGY-2) and subsequent planning of care.
3. Education. Learn clinical evaluation, diagnostic approach and treatment options for the surgical patient. Develop procedural skill and operative decision making. In addition, evaluation, diagnosis, clinical management of patients with general surgical diagnoses will be a significant part of the PGY-2 experience.
4. Weekly clinic attendance for PGY-3.
5. Attendance to Morbidity and Mortality, Grand Rounds, all resident didactic lectures and all relevant conferences.
6. Operating room. All cases should be covered by a member of the resident team
PGY-1
1. The daily care of all inpatients admitted to the General Surgery service. The resident should know all information regarding clinical course, management and plan on each patient. In addition, the PGY-1 should be familiar with all aspects of care regarding consults.
2. Education. Goals for the PGY-1 include pre and postoperative care of the surgical patient. These include but are not limited to appropriate skills in medical management, understanding and decision making regarding the preoperative care of the variety of general surgical diseases, performance of minor bedside procedures (see below) as well as those performed in the operating room. In addition, the PGY-1 will actively participate in the departmental didactics, conferences and journal club. Presence at all conferences is mandatory.
Evaluation
Evaluation meetings will take place with the PGY-5 and 2 at the mid and end point of the rotation. PGY-1 will meet with an attending for review at the end of their rotation. Clinical evaluations are based on observations in the areas of the core competencies (patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism and systems-based practice. For more information regarding core competencies refer to the following web site: http://www.acgme.org/outcome/comp/compFull.asp). Attending evaluations will be based on achievement of objectives as outlined above and will be based on input from the following:
1. Attending-resident interaction during rounds, the operating room, consultation assessment, daily rounds and other clinical responsibilities.
2. Presentation at M&M
3. Performance in the operating room in terms of pre-operative planning, dexterity, intraoperative judgment and ability to act autonomously.
4. Nursing and patient evaluations
5. Medical student interaction and evaluation. The ability of residents to teach medical students is of primary importance and is a major objective of the rotation.
Cases
PGY-1
Foley catheter insertion
Intravenous lines
Arterial blood gas
Central lines
Port insertion
Assisting in laparoscopy
Hernia
Skin tumor excisions
Appendectomy
PGY-2/3
Basic Laparoscopy
Laparoscopic cholecystectomy
Laparoscopic appendectomy
Laparoscopic hernia
Hernias
Feeding tube placements
Gastrostomy tube placement
Hemorrhoid surgery
Small bowel surgery
Colectomy
PGY-5
All major abdominal surgery
Surgery for morbid obesity
Advanced laparoscopy
l Fundoplication
l Esophageal myotomy
l Small and large bowel surgery
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